肝细胞肝癌外科治疗方法的选择

2008年9月底制定了肝细胞肝癌外科治疗方法的选择,全文如下.     

Estrogen Activation of G-Protein–Coupled Estrogen Receptor 1 Regulates Phosphoinositide 3-Kinase and mTOR Signaling to Promote Liver Growth in Zebrafish and Proliferation of Human Hepatocytes

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肝细胞肝癌外科治疗方法的选择

2008年9月底制定了肝细胞肝癌外科治疗方法的选择,全文如下.     

Measuring Alterations in Intra-Abdominal Pressure During Abdominoplasty as a Predictive Value for Possible Postoperative Complications

The purpose of this study was to measure the changes in Intra-Abdominal Pressure (IAP) during abdominoplasty and the relevance of these changes to the immediate postoperative recovery period. Eighteen patients (17 females and one male) who underwent abdominoplasty for aesthetic reasons participated in the study. The data collected included measurements of height, weight, and measurements of the intra-urinary bladder pressure prior to surgery, immediately post operative, and 18–24 hours postoperative. Changes in tidal volume and ventilation pressures were also measured prior to surgery and immediately postoperative. The weight of the excised tissue ranged between 1150 g–6500 g with an average of 2700 g. Three patients had significant diasthesis recti repair during surgery. In these patients the measured intra-vesicular pressure was above 24 cm of H₂O by the end of the operation and above 20 cm of H₂O the day following surgery. Two out of the three patients were treated with anticoagulants and the symptoms subsided within a week. The third patient recovered spontaneously by the third day. In conclusion, patients with an intra-urinary bladder pressure above 20 cm of H₂O following abdominoplasty were felt to be at significant risk for development of respiratory distress in the immediate postoperative period.     

Subcutaneous sacrococcygeal myxopapillary ependymoma

A case of subcutaneous sacrococcygeal ependymoma in a child is reported. A review of the literature is made, emphasizing the pediatric population. In contrast to the other forms of ependymomas that generally do not metastasize, the sacrococcygeal variety does disseminate even after many years. Complete local excision is required. Postoperative radiotherapy may be necessary for residual tumor. Long-term follow-up is essential.     

Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate.

Changes in the level of biochemical markers of bone resorption with risedronate treatment for osteoporosis were examined as a surrogate for the decrease in fracture risk. Greater decreases in bone resorption markers were associated with greater decreases in vertebral (and nonvertebral) fractures. Antifracture efficacy of antiresorptive therapies is only partially explained by increases in bone mineral density. Early decreases in bone resorption may also play a role. We tested this hypothesis by measuring two bone resorption markers, the C-telopeptide of type I collagen (CTX) and the N-telopeptide of type I collagen (NTX), in osteoporotic patients in risedronate vertebral fracture trials. We studied 693 women with at least one vertebral deformity (mean age, 69 +/- 7 years) who received calcium (and vitamin D if required) and placebo or risedronate 5 mg daily for 3 years. The reductions in urinary CTX (median, 60%) and NTX (51%) at 3-6 months with risedronate therapy were significantly associated (p < 0.05) with the reduction in vertebral fracture risk (75% over 1 year and 50% over 3 years). The changes in both CTX and NTX accounted for approximately one-half (CTX, 55%; NTX, 49%) of risedronate's effect in reducing the risk of vertebral fractures in the first year and approximately two-thirds (CTX, 67%; NTX, 66%) over 3 years compared with placebo. The changes in CTX and NTX accounted for 77% and 54%, respectively, of risedronate's effect in reducing the risk of nonvertebral fractures over 3 years compared with placebo. The relationships between vertebral fracture risk and changes from baseline in CTX and NTX were not linear (p < 0.05). There was little further improvement in fracture benefit below a decrease of 55-60% for CTX and 35-40% for NTX. The decrease in bone resorption in patients taking risedronate accounts for a large proportion of the reduction in fracture risk. There may be a level of bone resorption reduction below which there is no further fracture benefit.     

Subepithelial hemorrhage of renal pelvis simulating neoplasm (Antopol-Goldman lesion)

Two cases of peripelvic hemorrhage simulating tumors (Antopol-Goldman lesion) are reported. In the 2 cases, nephrectomies were performed. With more knowledge of this lesion, and of its rapid disappearance, a waiting period and repeated intravenous pyelogram might prevent some unnecessary surgery.     

Eosinophilic Fibrohistiocytic Lesion of Bone Marrow: A Distinctive New Morphologic Finding, Probably Related to Drug Hypersensitivity

A distinctive, hitherto undescribedlesion was found in histologic sectionsof aspirated bone marrow particles infive patients. The lesion occurred inclose relation to lymphoid follicles,vessels, and sinusoids. It consisted ofcollections of cells with regular,spindle-shaped nuclei and poorly defined cytoplasmic borders. Amongthese cells, which were interpreted ashistiocytic and/or fibroblastic elements, there were abundant eosinophils, often in aggregates (eosinophilicabscesses), plasma cells, and a fewmast cells. Four of the patients wereanemic, and all took numerous drugsincluding ampicillin, procainamide,and allopurinol. In four patients, theanemia remitted after the suspecteddrug was discontinued. Repeated bonemarrow aspirates in three showed onlyan increased number of eosinophilsaround lymphoid follicles and bloodvessels in two patients and completedisappearance of the lesion in one.Hodgkin’s disease, eosinophilic granuloma, Kaposi’s sarcoma, and lipidgranuloma were considered in thedifferential diagnosis and were ruledout by histologic and clinical considerations.

Submitted on March 20, 1972 Revised on May 10, 1972 Accepted on May 15, 1972     

Limited use of complementary and alternative medicine in Israeli head and neck cancer patients

HYPOTHESIS/OBJECTIVE: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). STUDY DESIGN: Use of CAM was evaluated in a cohort of treated HNC patients. METHODS: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. RESULTS: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). CONCLUSION: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients.     

Intussusception in children: can we rely on screening sonography performed by junior residents?

Background Ultrasonography is an important tool in the screening and diagnosis of patients with suspected intussusception.Objective To retrospectively evaluate the accuracy and performance of junior residents and compare it to that of senior residents and staff radiologists.Materials and methods Between January 1999 and February 2003, 151 patients with suspected intussusception underwent screening US. The mean age of the patients was 13.8 months. Patients were divided into three groups according to examiner: staff radiologist, senior resident or junior resident.Results Sixty-five patients had both US and air enema. Forty-four patients had a positive US result; 37 (84%) were true positive and 7 (16%) were false positive. Twenty-one patients had a negative US result; 18 (86%) were true negative and 3 (14%) were false negative. Eighty-six patients underwent screening US only and were then kept under observation in the emergency room. They were all diagnosed as having a non-surgical condition. The total accuracy rate was 93%, sensitivity was 84%, specificity was 97%, positive predictive value was 93% and negative predictive value was 94%. Accuracy rate, sensitivity and specificity were 92%, 85% and 98% for staff radiologists, 94%, 75% and 96% for senior residents and 95%, 83% and 97% for junior residents, respectively.Conclusions Junior residents perform as well as staff radiologists in screening US for suspected intussusception and have gained both the respect and confidence of the paediatricians.